Silent Strangulation: A Case Report of the Unseen Threat of Nuchal Cord Discovered During Caesarean Section
1Delta State University Abraka and Delta State University Teaching Hopsital, Oghara
2God's Spring Best Care Hospital, Benin City and Zion Clinic & Maternity, Benin City, Nigeria
3Delta State University Teaching Hospital, Oghara, Delta State
4God's Spring Best Care Hospital, Benin City
Abstract
Background: Nuchal cord one or more loops of umbilical cord around the fetal neck is a common finding, with global incidence ranging from 3% to 38%. Although typically benign, multiple or tightly wound loops may cause significant perinatal complications.
Case Presentation: We report a rare case of a 36-year-old primiparous woman induced at 41 weeks for postdatism and reduced fetal movements. Despite normal antenatal findings, persistent variable decelerations during labour prompted emergency caesarean section. Intraoperatively, three tight nuchal cord loops were discovered. The male neonate was delivered with moderate asphyxia (1-minute Apgar score 5) but responded to resuscitation, attaining 5-minute and 10-minute Apgar scores of 8 and 10, respectively.
Discussion and Conclusion: The case highlights the diagnostic limitations of routine antenatal ultrasonography in detecting tight nuchal cords, particularly in low-resource settings. It emphasizes the importance of individualized clinical assessment, vigilant monitoring during labour, and maintaining a high index of suspicion when fetal distress persists despite conservative interventions.
Data Availability
All relevant data are included within the article.
Author Biographies
Dr. Innocent Okoacha
Delta State University Abraka and Delta State University Teaching Hopsital, Oghara
Department of Obstetrics and Gynaecology; Clinical Lecturer and Consultant Obstetrician & Gynaecologist
Dr. Osarenmwinda Joshua
God's Spring Best Care Hospital, Benin City and Zion Clinic & Maternity, Benin City, Nigeria
General Medical Practice; Medical Officer.
Dr. Rukevwe M. Odukuye
Delta State University Teaching Hospital, Oghara, Delta State
Department of Anaesthesia and Intensive Care Unit; Consultant Anaesthetist
Dr. Kingsley D. Anim
God's Spring Best Care Hospital, Benin City
General Medical Practice; Medical Officer
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Published in Vol. 8 No. 1 (2025): African Journal of Tropical Medicine and Biomedical Research, June 2025.
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